Vasodilator Stress CMR and All-Cause Mortality in Stable Ischemic Heart Disease

Marcos‐Garcés, Víctor; Gavara, José; Monmeneu, José V.; López‐Lereu, María P.; Bosch, María José; Merlos, Pilar; Pérez, Nerea; Ríos‐Navarro, César; Dios, Elena de; Bonanad, Clara; Racugno, Paolo; Navarro, Alejandro; Perez, Bruno Ventura; Botella, Jose Aguilar; Ventura, Silvia Mastrolembo; Mainar, Luis; Cánoves, Joaquín; Pellicer, Mauricio; Moratal, David; Miñana, Gema; Núñez, Julio; Chorro, Francisco J.; Bodı́, Vicente

doi:10.1016/j.jcmg.2020.02.027

Cited by 39 publications

(64 citation statements)

References 22 publications

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“…Two meta-analysis showed that any degree of ischemia on stressCMR was predictive of a combined major adverse cardiac events (MACE) endpoint comprised of cardiovascular (CV) death and non-fatal myocardial infarction [ 10 , 11 ]. Overcoming this dichotomized approach (presence vs. absence of inducible ischemia), recent research has shown that the amount of ischemia (what is called “ischemic burden”) can be used to further stratify the prognosis: The more extensive the ischemic burden, the higher the risk of adverse cardiovascular events [ 13 , 24 , 25 , 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…Technical aspects related to CMR studies are depicted elsewhere [ 13 , 15 , 16 ]. All studies were carried out and reported by two cardiologists accredited by the European Society of Cardiology with >10 years of experience in the use and interpretation of vasodilator stress CMR testing.…”

Section: Methodsmentioning

confidence: 99%

“…Inter- and intra-observer variability for all CMR indices used in the present registry can be consulted elsewhere [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

“…For the sake of simplicity and clinical applicability, and only to obtain the score, continuous variables were dichotomized using clinically meaningful cutoff points. Cut-off values have been previously validated for prognostic purposes in CAD: more than 65 years-old for age to define the elderly population, less than 50% for LVEF to define reduced ejection fraction [ 18 ] and more than 5 ischemic segments on stressCMR to define patients with extensive ischemia [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

“…In the midst of a paradigm shift in health systems to deliver the most verifiable outcomes, all-cause death appears unarguable. Using all-cause death as the only end-point, we have recently reported the potential of stress-CMR for stratifying risk and guiding decision-making in CCS patients [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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A Novel Clinical and Stress Cardiac Magnetic Resonance (C-CMR-10) Score to Predict Long-Term All-Cause Mortality in Patients with Known or Suspected Chronic Coronary Syndrome

Marcos‐Garcés

Gavara

Monmeneu

et al. 2020

JCM

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Vasodilator stress cardiac magnetic resonance (stressCMR) has shown robust diagnostic and prognostic value in patients with known or suspected chronic coronary syndrome (CCS). However, it is unknown whether integration of stressCMR with clinical variables in a simple clinical-imaging score can straightforwardly predict all-cause mortality in this population. We included 6187 patients in a large registry that underwent stressCMR for known or suspected CCS. Several clinical and stressCMR variables were collected, such as left ventricular ejection fraction (LVEF) and ischemic burden (number of segments with stress-induced perfusion defects (PD)). During a median follow-up of 5.56 years, we registered 682 (11%) all-cause deaths. The only independent predictors of all-cause mortality in multivariable analysis were age, male sex, diabetes mellitus (DM), LVEF and ischemic burden. Based on the weight of the chi-square increase at each step of the multivariable analysis, we created a simple clinical-stressCMR (C-CMR-10) score that included these variables (age ≥ 65 years = 3 points, LVEF ≤ 50% = 3 points, DM = 2 points, male sex = 1 point, and ischemic burden > 5 segments = 1 point). This 0 to 10 points C-CMR-10 score showed good performance to predict all-cause annualized mortality rate ranging from 0.29%/year (score = 0) to >4.6%/year (score ≥ 7). The goodness of the model and of the C-CMR-10 score was separately confirmed in 2 internal cohorts (n > 3000 each). We conclude that a novel and simple clinical-stressCMR score, which includes clinical and stressCMR variables, can provide robust prediction of the risk of long-term all-cause mortality in a population of patients with known or suspected CCS.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…Inter- and intra-observer variability for all CMR indices used in the present registry can be consulted elsewhere [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Novel Clinical and Stress Cardiac Magnetic Resonance (C-CMR-10) Score to Predict Long-Term All-Cause Mortality in Patients with Known or Suspected Chronic Coronary Syndrome

Marcos‐Garcés

Gavara

Monmeneu

et al. 2020

JCM

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Diagnostic and Prognostic Value of Stress Cardiovascular Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease

et al. 2023

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ImportanceThe clinical utility of stress cardiovascular magnetic resonance imaging (CMR) in stable chest pain is still debated, and the low-risk period for adverse cardiovascular (CV) events after a negative test result is unknown.ObjectiveTo provide contemporary quantitative data synthesis of the diagnostic accuracy and prognostic value of stress CMR in stable chest pain.Data SourcesPubMed and Embase databases, the Cochrane Database of Systematic Reviews, PROSPERO, and the ClinicalTrials.gov registry were searched for potentially relevant articles from January 1, 2000, through December 31, 2021.Study SelectionSelected studies evaluated CMR and reported estimates of diagnostic accuracy and/or raw data of adverse CV events for participants with either positive or negative stress CMR results. Prespecified combinations of keywords related to the diagnostic accuracy and prognostic value of stress CMR were used. A total of 3144 records were evaluated for title and abstract; of those, 235 articles were included in the full-text assessment of eligibility. After exclusions, 64 studies (74 470 total patients) published from October 29, 2002, through October 19, 2021, were included.Data Extraction and SynthesisThis systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Main Outcomes and MeasuresDiagnostic odds ratios (DORs), sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), odds ratio (OR), and annualized event rate (AER) for all-cause death, CV death, and major adverse cardiovascular events (MACEs) defined as the composite of myocardial infarction and CV death.ResultsA total of 33 diagnostic studies pooling 7814 individuals and 31 prognostic studies pooling 67 080 individuals (mean [SD] follow-up, 3.5 [2.1] years; range, 0.9-8.8 years; 381 357 person-years) were identified. Stress CMR yielded a DOR of 26.4 (95% CI, 10.6-65.9), a sensitivity of 81% (95% CI, 68%-89%), a specificity of 86% (95% CI, 75%-93%), and an AUROC of 0.84 (95% CI, 0.77-0.89) for the detection of functionally obstructive coronary artery disease. In the subgroup analysis, stress CMR yielded higher diagnostic accuracy in the setting of suspected coronary artery disease (DOR, 53.4; 95% CI, 27.7-103.0) or when using 3-T imaging (DOR, 33.2; 95% CI, 19.9-55.4). The presence of stress-inducible ischemia was associated with higher all-cause mortality (OR, 1.97; 95% CI, 1.69-2.31), CV mortality (OR, 6.40; 95% CI, 4.48-9.14), and MACEs (OR, 5.33; 95% CI, 4.04-7.04). The presence of late gadolinium enhancement (LGE) was associated with higher all-cause mortality (OR, 2.22; 95% CI, 1.99-2.47), CV mortality (OR, 6.03; 95% CI, 2.76-13.13), and increased risk of MACEs (OR, 5.42; 95% CI, 3.42-8.60). After a negative test result, pooled AERs for CV death were less than 1.0%.Conclusion and RelevanceIn this study, stress CMR yielded high diagnostic accuracy and delivered robust prognostication, particularly when 3-T scanners were used. While inducible myocardial ischemia and LGE were associated with higher mortality and risk of MACEs, normal stress CMR results were associated with a lower risk of MACEs for at least 3.5 years.

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Risk of death associated with incident heart failure in patients with known or suspected chronic coronary syndrome

et al. 2022

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Aims Traditional adverse events in chronic coronary syndrome (CCS) include atherothrombotic events but usually exclude heart failure (HF). Data are scarce about how new‐onset HF modifies mortality risk. We aimed to determine the incidence of HF and compare its long‐term mortality risk with myocardial infarction (MI) and stroke in patients with known or suspected CCS. Methods We prospectively evaluated 5811 consecutive HF‐free patients submitted to vasodilator stress cardiac magnetic resonance (CMR) for known or suspected CCS. Ischaemic burden and left ventricular ejection fraction were assessed by CMR. HF included outpatient diagnosis or acute HF hospitalization. The mortality risk for the incident events and their cross‐comparisons were evaluated using a Markov illness–death model with transition‐specific survival models. Results The mean age was 55 ± 11 years, and 38.9% were female. At a median follow‐up of 5.44 (IQR = 2.53–8.55) years, 591 deaths were registered (1.79 per 100 P‐Y). The rates of new‐onset HF were higher compared with MI and stroke [1.02, 0.62, and 0.51, respectively ( P < 0.05)]. The adjusted association between new‐onset HF, MI, and stroke, and subsequent mortality was time dependent. The risk increased almost linearly for HF and became significant by the third year. By Year 10, the mortality risk attributable to new‐onset HF was more than 2.5‐fold (HR: 2.68, 95% CI = 1.74–4.12). For MI, there was a significant increase in mortality risk up to the second year, followed by a monotonic decrease. For stroke, the mortality risk increased for the entire follow‐up but became significant by the third year. A cross‐comparison among incident endpoints HF outnumbers risk for those with MI by the sixth year (HR year6.3 : 1.88, 95% CI = 1.03–3.43). There was no difference in mortality risk between incident HF and stroke. Conclusions In patients with CCS, long‐term rates of incident HF were higher than MI and stroke. Patients with new‐onset HF showed a higher risk of long‐term mortality.

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Vasodilator Stress CMR and All-Cause Mortality in Stable Ischemic Heart Disease

Cited by 39 publications

References 22 publications

A Novel Clinical and Stress Cardiac Magnetic Resonance (C-CMR-10) Score to Predict Long-Term All-Cause Mortality in Patients with Known or Suspected Chronic Coronary Syndrome

A Novel Clinical and Stress Cardiac Magnetic Resonance (C-CMR-10) Score to Predict Long-Term All-Cause Mortality in Patients with Known or Suspected Chronic Coronary Syndrome

Diagnostic and Prognostic Value of Stress Cardiovascular Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease

Risk of death associated with incident heart failure in patients with known or suspected chronic coronary syndrome

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